How else can therapeuticcommunities be modified?

More recently, research efforts have sought to determine how to modify TCs to accommodate the realities and constraints of a managed care health environment. Major adaptations being tested include the impact of shorter lengths of stay and the use of a day treatment model.

Shorter lengths of stay

Originally, the TC was envisioned as an alternative community that had no specific length of stay. As the TC developed into a mainstream treatment modality and external pressures emerged to manage treatment resources more efficiently, the expected length of treatment became shorter -- first to around 24 months and now to around 12 months.

One study compared two TCs differing in the length of residential stay. The planned treatment duration was 12 months in each program, but one was designed as a 9-month residential/3-month outpatient program and the other was a
6-month residential/6-month outpatient phase. No statistically significant differences in outcomes were found between these treatment designs, except that the program with the 9-month residential phase produced better employment outcomes. However, successful outcomes depended more on completing both phases of the programs than on the length of the residential phase.

The day treatment TC

The day treatment TC is less intensive than residential TC treatment but more intensive than the typical outpatient drug treatment program. Day treatment TCs employ a community approach and the principles of mutual self-help. They can be helpful in preparing a person for entry into a residential program or may serve as a "step down" modality after the residential phase is complete. Day treatment TCs can also provide comprehensive, self-contained treatment for those who may not need residential care.

In a study comparing a day treatment TC with a traditional residential TC, the day treatment TC produced outcomes comparable to the traditional TC, including reduction in alcohol and drug use and improvement in many problem areas. Possibly because of poorer retention rates, the day treatment program was not as successful as the traditional TC with those who had severe social and psychiatric problems. The traditional residential TC also had better outcomes for employment, an area heavily emphasized in most residential TC programs. However, for those with less severe mental health and social functioning problems, the day treatment TC may be more cost-effective.